Rom J Morphol Embryol 2016, 57(1):307–311 ISSN (print) 1220–0522 ISSN (online) 2066–8279 CASE REPORT Atypical case of Sjögren’s syndrome with psychiatric and peripheral neurological disorder NICOLETA ANAMARIA PAŞCALĂU 1) , FELICIA LIANA CIOARĂ 1) , ELENA ROŞCA 2) , GABRIELA MUŢIU 3) , LIANA OANA POBIRCI 1) , CRISTIAN MARIUS JINCA 4) , LAURA MONICA GEORGESCU 5) , RĂZVAN-MARIUS VICAŞ 3) 1) Department of Neurosciences and Rehabilitation, Faculty of Medicine and Pharmacy, University of Oradea, Romania 2) Department of Anatomy, Faculty of Medicine and Pharmacy, University of Oradea, Romania 3) Department of Morphological Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Romania 4) Department of Pediatrics, “Victor Babeş” University of Medicine and Pharmacy, Timisoara, Romania 5) Department of Medical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Romania Abstract Sjögren’s syndrome is a rare disorder of the immune system characterized by the chronic lymphocytic infiltration of the organs with exocrine secretion (lachrymal, salivary glands), but also of other tissues of the body, that can be primary or secondary and can appear alone or in association with other systemic diseases: rheumatic arthritis, systemic erythematous lupus, scleroderma or polymyositis/dermatomyositis. The case that we are presenting is that of a 40-year-old man, who came to the Department of Rheumatology with articular, muscular, ocular, psychological and neurological symptoms. After multiple biological, immunological, histological, neurological, psychiatric, ophthalmological, digestive investigations, it was reached the conclusion that the patient presents a rare autoimmune disease (primary Sjögren’s syndrome) involving mainly peripheral neuromuscular and psychological (small frequency) and the patient was given specific immunomodulatory, anti- inflammatory and anti-depressive treatment, to which he responded well. Thus, after 18 months of investigation, severe depressive episodes and difficult collaboration of the patient with the medical team, it was possible to reach the definitive diagnosis and to perform the appropriate treatment. Keywords: Sjögren’s syndrome, autoimmune disease, rheumatology.  Introduction The human body is frequently the target of external attacks (viruses, bacteria, allergens, toxic substances) that can weaken him; more seriously is the case when the protection cells of the body fight against the tissues, not recognizing them as their own structures [1]. The result is unpredictable and variable; there are major differences from one patient to another. The involvement of the central and peripheral nervous system is proven in many studies [2]. The psychological symptoms most frequently related are anxiety, depression and somatization, as well as cognitive and memory problems [3]. The peripheral neuropathy is manifested most frequently by muscle weakness, decrease of the muscular strength and seems related to the lympho- cyte infiltration of the small blood vessels that serve the nerves [4]. Prevalence of neurological manifestations in Sjögren’s syndrome varies widely from 10 to 60%, with pure or predominantly sensory polyneuropathies as the most common neurological manifestation (e.g., sensory ataxic or small fiber sensory painful neuropathy). Mononeuropathy multiplex, polyradiculopathy, symptomatic dysautonomia, cranial neuropathy, myopathy, and central nervous system involvement are less common [4, 5]. Normally, the symptoms are well tolerated by the patient, but there are also aggressive and unclear forms. We report such a case to literature data and discussions on the diagnosis, treatment and results.  Case presentation The case that we are presenting is of a 40-year-old man, who came to the Department of Rheumatology with non-specific symptoms: non-systematized arthralgia with inflammation, muscular pain, severe physical asthenia, fatigue, irascibility, depression, insomnia. The presented case is rare from many reasons. The immunological investigations were not eloquent from the beginning, the muscular biopsy showed atrophic inflammatory modifi- cations, the biopsy of the salivary gland was refused by the patient, the Schirmer’s test was positive and articular and neurological symptoms were predominant. The patient noted for the first time, approximately two years ago, muscular weakness at the lower and upper limbs, fatigability, insomnia, articular diffuse pain, with inflammatory character, at the lumbosacral spine, knees, shoulders, without objective clinical modifications. Initially, the patient was evaluated rheumatologically in a university center. A spondylitis was suspected; the antinuclear anti- body (ANA) profile was negative, HLA-B27 antibody was positive, the ophthalmological exam was negative, the neurological exam in normal limits, and in the absence of an inflammatory biological process, the articular and vertebral X-rays performed – without modifications, did not sustain the diagnosis. Due to the persistence of the subjective complaints, we initiated treatment with Sulfa- salazine in progressively increased doses up to 3 g/day for three months and Medrol 32 mg/day, in progressively R J M E Romanian Journal of Morphology & Embryology http://www.rjme.ro/